PICU Flashcards
At what pressure does the pop off valve come off a self-inflating bag?
40-45mmHg
What is the first type of drugs to be used in a planned intubation?
vagolytics- atropine of glycopyrollate as the mechanical pressures of intubation/laryngoscopy causes a vagal response and bradycardia. You can give these drugs to stop that.
Thiopental
Pentathal, barbituate; Very fast time of onset /offset 5-10min. Primary effect is sedation. Good to control increased ICP. Bad for hemodynamics. 2-4mg/kg. No amnesia or analgesia
Ketamine
Sedation, amnesia, and analgesia. Not good for ICP, good for hemodynamics, good for RAD b/c bronchodilator. Causes release of catecholines and maintain bp. 1-3mg/kg. Can give IM. Can get bad dreams (can add versed). Causes increased secretions
Benzo and narcotic combo
Most common versed and fentanyl. Sedate without losing bp or protective airway. Cause amnesia and analgesia and sedation. Lasts for 30-45 min.
Dose of versed and fentanyl for procedures
0.1mg/kg versed. 2-4ug/kg fentanyl
Propofol
Onset 60s, offset 5-10min. Good for ICP, bad for hemodynamics. Feel great after waking up.
Etomidate
Best for hemodynamic instability. 0.2mg/kg. Can cause clonic activity. Can get adrenal suppression. Not recommended for kids with septic shock.
Lidocaine
Good for control of RAD and ICP. Optional adjunct
Succinylcholine
Depolarizing muscle relaxant. Antagonist to postsynaptic Ach receptors, but causes muscle twitch. duration 5-10minutes. Can cause potassium to go up. Contraindic: hyperkalemia, congenital myopathy, burns, trauma, spinal cord trauma. Advantage: very potent, very fast 60s onset, 5-10min offset. Emergency drug
What are non-depolarizing agents
Pancuronium, Vecuronium, ciscuronium; onset 2-3 min, last 30-40 minutes. dependent on renal excretion. Contraindic: Renal failure
Pancuronium
vagolytic
Cisatricarium
Non steroidal. Hoffman degradation, not renal or hepatic excretion. 2-3min onset time, 20min offset. More expensive.
Rocuronium
Non-depolarizing, more hepatic than renal. Works quickly, 1-2 min onset, 20-40min offset.
What is the first type of drugs to be used in a planned intubation?
vagolytics- atropine of glycopyrollate as the mechanical pressures of intubation/laryngoscopy causes a vagal response and bradycardia. You can give these drugs to stop that.
Thiopental
Pentathal, barbituate; Very fast time of onset /offset 5-10min. Primary effect is sedation. Good to control increased ICP. Bad for hemodynamics. 2-4mg/kg. No amnesia or analgesia
Ketamine
Sedation, amnesia, and analgesia. Not good for ICP, good for hemodynamics, good for RAD b/c bronchodilator. Causes release of catecholines and maintain bp. 1-3mg/kg. Can give IM. Can get bad dreams (can add versed). Causes increased secretions
Benzo and narcotic combo
Most common versed and fentanyl. Sedate without losing bp or protective airway. Cause amnesia and analgesia and sedation. Lasts for 30-45 min.
Dose of versed and fentanyl for procedures
0.1mg/kg versed. 2-4ug/kg fentanyl
Propofol
Onset 60s, offset 5-10min. Good for ICP, bad for hemodynamics. Feel great after waking up.
Etomidate
Best for hemodynamic instability. 0.2mg/kg. Can cause clonic activity. Can get adrenal suppression. Not recommended for kids with septic shock.
Lidocaine
Good for control of RAD and ICP. Optional adjunct
Succinylcholine
Depolarizing muscle relaxant. Antagonist to postsynaptic Ach receptors, but causes muscle twitch. duration 5-10minutes. Can cause potassium to go up. Contraindic: hyperkalemia, congenital myopathy, burns, trauma, spinal cord trauma. Advantage: very potent, very fast 60s onset, 5-10min offset. Emergency drug
What are non-depolarizing agents
Pancuronium, Vecuronium, ciscuronium; onset 2-3 min, last 30-40 minutes. dependent on renal excretion. Contraindic: Renal failure
Pancuronium
vagolytic
Cisatricarium
Non steroidal. Hoffman degradation, not renal or hepatic excretion. 2-3min onset time, 20min offset. More expensive.
Rocuronium
Non-depolarizing, more hepatic than renal. Works quickly, 1-2 min onset, 20-40min offset.
What type of pressures should you aim for when intubating an asthmatic?
tidal volume 5-6mL/kg, plateau pressure not above 35mmHg
How do you decrease air trapping in asthmatic?
- Administer bronchodilator 2. increase expiratory time 3. Decrease tidal volume and minute ventilation
Which sedatives are good for asthmatics?
isoflurane or ketamine
How do you determin ET size?
Estimated size of inner diameter of uncuffed endotracheal tube (in mm) =
(Patient age in years / 4) + 4
How do you determine the depth of ET tube?
age/2 +12
What is dose of atropine in pediatric code?
0.02mg/kg
What is dose of adenosine in pediatric code?
0.1mg/kg
Amiodoarone dose in a code?
5mg/kg
Initial defibrillation joules?
2J/kg
repeat defibrillation joules?
4J/kg x2
Defibrillation (cardioversion)
0.5-1J/kg
Dose of epinephrine in codes
0.01mg/kg or 0.1ml/kg of 1:10,000 soln IV
Dose of epi for anaphylaxis
0.01mg/kg of 1:1000 soln IM
What dose of glucose bolus should be given for hypoglycemia?
2-4ml/kg of D25W over 20minut
Does of Bicarc
1meq/kg
